Frequently Asked Questions: Behavior Problems
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1. My son is three and undiagnosed. He had a brain injury sometime during my third trimester, but he seems to be pretty unique. His oral/motor skills are the most severely impacted. Our son makes very few sounds and communicates mostly by pointing and grunting. Lately he has become very aggressive with his two-year-old sister. He pulls her hair, grabs her around the neck and face and pinches her. He is very tall for his age and can reach our entire counter, which he is constantly grabbing things from. He is constantly getting into mischief and often destroying our property and/or putting himself in danger.
Our neurologist has told us that he has never seen a brain like his! He is delayed in all areas, but is walking. I know a lot of his behavior is because he is frustrated. We are currently working with his therapist to come up with a communication plan. It is going to take some time, however, and we can't allow him to act the way he is. We have tried spanking for things that are dangerous. We also have tried timeouts, but the battle becomes more about staying in the chair and less about the behavior.
I am at my wits end! I am constantly battling with him and starting to feel as if I don't like him. He is very precious to me and I hate how I feel towards him lately. If you have any advice or can recommend any literature, I would greatly appreciate it.
Loving your child but not liking him is a heartbreak like no other. Your letter is painful to read. It takes courage to own up to the dark and uncomfortable, yet so natural, feelings you describe. I am sure that many readers can identify with the situation you describe, especially because children with special needs can evoke our deepest passions.
The focus on developing your son's communication system is the key to the long term improvement of the situation. As he develops a way to communicate his needs and wants, his behavior will improve, and you will enjoy him more. I have seen this happen over and over again during my twenty years of professional as well as personal experience.
In terms of what you describe as your son's aggressive behavior towards your daughter, there may be another way to interpret what is going on. Perhaps he is trying to get her attention and to interact with her. As she matures, she will develop her own ways to handle her brother. In the meantime, you might seek a therapist who can work with your children together to help with their interactions as well as with your interactions with your son.
Your attempts to discipline your son sound very frustrating. All children need to be disciplined according to their individual needs. If your son, for example, does not understand the purpose of a time out, and if it doesn't help the situation, then consider dropping that form of guidance.
As far as spanking goes, I appreciate your honesty, but I must point out that punishment does not teach a child how to act. It may possibly teach a child how not to act. I think that the most important point you raise is how difficult your life is and how little joy you have with your son. To help in this area, I strongly recommend the “Floor Time” approach as described by Stanley Greenspan, M.D. and Serena Wieder, Ph.D. in “The Child with Special Needs: Encouraging Intellectual and Emotional Growth.” This approach of joining your child where he is and following his lead in play can bring some joy back to the relationship. It may also help in the relationship between your son and daughter.
Each child is so unique, so puzzling, and ultimately so rewarding. The limitations to his brain challenge all who love him to grow their brains in new ways and heal their broken hearts. I wish you well in your quest.
2. My son has a Traumatic Brain injury. He received it as a result of being thrown from our vehicle, when we had a very horrible car accident when he was 4. He is now 12. His behavior has become increasingly worse. He at times is very loving but more often is very angry and verbally and at times physically abusive. Due to his behavior he has a lot of trouble with peers as well as family. I never get a break because no one can handle him when he gets out of control. My fiancée and I have been together for 4 1/2 years. During that time we have had many problems with our relationship partly because of my son's problems. He has tried to be patient and understanding and involved in my son's therapy. I guess I just hope some day our lives can become more normal! We all miss out on a lot of enjoyable family time due to the unpredictable outbursts. Any help you can provide will be greatly appreciated!
Your son is at a difficult age for any child, typical or not. Not knowing his cognitive level or communication skills, it is difficult for me to comment on his behavior in a detailed way. When a child has been traumatized, however, more often than not the whole family is affected to some degree or another. Your relationship may also be fragile, as a result, for it is hard to go on indefinitely missing out on what you describe as "normal family fun." On the other hand it is hard to let go of the drive to care for your injured child. I am sure that the hearts of many readers go out to you and your fiancé whom you are certainly blessed to have by your side. First, I would suggest making time for whatever type of fun activities that work for your family. Try to follow your son's lead in ways that can be fun for everyone as child psychiatrist Stanley Greenspan describes in his "floor time" approach. You can read about this approach in detail in "The Child with Special Needs: Encouraging Intellectual and Emotional Growth" by Greenspan and Serena Wieder, Ph.D., which I mention frequently in this column. Secondly, I would suggest that you consider getting help for the specific problem behaviors which are making life difficult for your family. The rule of thumb which I suggest to people is that when you spend more time not enjoying your child than enjoying your child, it is time to seek professional guidance. There is probably no easy answer or the therapists who work with your son would have found it by now. There may be better ways to deal with the problem behaviors which may be found to be somewhat predictable to a skilled professional. Thirdly, however difficult it may be, it is essential for your own mental health and for your relationship to find someone who can handle your child so that you and your fiancé can enjoy time together without the stresses and strains of the problems you describe. In most states respite care is available through your local developmental disabilities or mental retardation program. You might also find someone through the special education department of a local college or university where many students are eager to get experience as they develop skills for a career helping children with special needs. I encourage you to reach out further--it is time. RN
3. I am at wits end. My 16 year old son is exhibiting some behaviors that we are not sure how to handle. He was born with hydrocephalus and as a result has cerebral palsy (wheelchair dependent), is probably totally blind, seizure disorder, development delays, speech impairment and is medically fragile. For the past 3 years I have home-schooled him with the blessings and support services from our school system. Since he reached puberty we have been having some different problems with him. He cannot talk but communicates somewhat effectively with signs that we have taught him. The signs he uses include; want, toy, stop, nite-nite, smell, listen, and yes. I feel that most of his behavior problems stem from not being able to communicate everything he wants to get across. His receptive language is much higher than his expressive. He will hit himself and others when he cannot get his point across, and will also cry, he knows what he wants but we don't. He will also try to hit people who just come up to him to say hello (at church, family gatherings, etc.). I am not sure how to correct him so that he will know that I want him to stop the bad behavior, not the signing, etc. I know he also has some sensory problems, and some of this may have something to do with that. He likes everything to be on schedule, so he will know when things happen (because of his vision he does not know the time of day any other way), if someone comes to our house that I did not know was coming (I tell him when anybody is coming) and therefore could not prepare him, he just gets all "bent out of shape" and hollers, and fusses the whole time they are here. I sure would appreciate any suggestions on how to handle these things. We are in the process of trying to get some advice and help through our local mental health facility, but because of some "red tape" and a misunderstanding about where we would meet (either in our home or their office) we have not been able to get going with that. Thanks.
When at your wits end, tie a knot and hang on. Adolescence can be very tough with any child. Some people think of this period as the “terrible twos grown up quite a bit.” A child like yours with so many special needs is obviously no exception. The last line of your letter sticks with me because I get the idea that you want the mental health professionals to come to your home. While this is often very helpful, it sounds like your child is already home most of the time and might benefit from doing things outside of the home. He needs to become more flexible and come to understand as best he can that everything is not so predictable. It is important not to give in to all of his outbursts. He may be able to learn things out in the world that will help him through the rest of his life.
Being the parent of a nonverbal child myself, I know first hand how frustrating it can be when your child is upset and you can't figure out what he wants or how to handle it. It can be extremely difficult to be in public. Generally as communication improves, this type of situation lessens, so the main strategy should be to continue as you have to develop a communication system. The behavior is a symptom of your child's frustration. When he hits and pushes that is a “sign” of his frustration, so in that sense he is communicating, and he needs to know that you understand him. One idea is to develop a sign that is more appropriate so that he can express this feeling. A speech therapist can work with him on this, while an occupational therapist can work on the sensory issues you mention.
Parents of other children with similar disabilities can be a great source of support and advice for they face similar challenges. I would strongly recommend that you consider reaching out and joining a parent group in your area. Such a group might be located through United Cerebral Palsy, www.ucpa.org . Since your child is blind, he might also be eligible for more services because of that sensory disability. If he has any loss of hearing, there is a nationwide network of programs that provide family support in each state. Try www.helenkeller.org You have come a long way, and I hope these brief comments might be helpful on the next leg of your journey. RN
4. My daughter Katie is suffering from Post Encephalitic Syndrome. She is physically 5 years old, but her mental age is 2 1/2. She has moderate brain damage and ADD.
My problem arises at school. Katie is enrolled in an all day Special Ed Kindergarten. When Katie gets angry (she also has verbal apraxia), she lashes out at whoever is in the way. She hits, spits, screams and has temper tantrums.
How can I help her to try and control her anger? She sometimes does this at home too, but I can usually get her to calm down and use her words. I am very frustrated. Please help!
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Take heart. You are on the right track in how you are approaching this. Your daughter is communicating her frustrations through her behavior. The key is to help Katie to calm herself enough to use her words. What you are doing right may help at school. A team approach may help you and her teacher and therapists to coordinate what works to help Katie in this way.
Everyone should remember that since your daughter is developmentally delayed by 2 and a half years that her behavior reflects that reality. I have seen what you describe with my own son, as well as with hundreds of other children with special needs. As communication skills improve, hitting, screaming, biting, and other problem behaviors tend to decrease rather rapidly. The same is true with typically developing two-year-olds who are going through the terrible twos.
Sometimes parents, educators, and mental health professionals focus too much on the problem behaviors. It can help to look at what is going on when those behaviors are absent. The absence of the problem can give us insight into how to have more time without the undesirable behavior. This kind of problem-solving approach can happen in team meetings and feel positive and productive to all parties.
It can break a parent's heart to see the kind of problems you are describing. You must want your child to catch up and act appropriately. That's only natural. Who would you be if you didn't feel that way? Children with special needs can be simultaneously endearing, loveable, frustrating and extremely challenging. Their behavior problems can stress their parents to unbelievable lengths. Sometimes, the grief over the typical child we may have lost is contained in our frustrations about these everyday challenges. Problems like those you describe can take the joy out of family life.
Try to spend as much time as you can enjoying your child. Remember most of all that it is absolutely key to take our child's developmental level into account. Joining her where she is, following her lead, having fun, and expanding communication will help her grow. This is true at home as well as in school. This developmental approach, developed by Stanley Greenspan, M.D. and others, can help us understand these behaviors and guide children towards more socially appropriate ways of expressing themselves.